[Hiring] Clinical Appeals Advocate @Baxter International Inc.

Role Description

As a Clinical Appeals Advocate, you will serve as a key patient advocate—supporting individuals who have been denied insurance coverage for Baxter’s Respiratory Health products. You will work directly with patients, healthcare teams, and insurance payers to overturn denials, secure access to medically necessary therapies, and advance our Mission to Save and Sustain Lives.

This role requires strong clinical understanding, excellent communication skills, and the ability to navigate complex payer policies. You will collaborate cross‑functionally with Respiratory Health teams, build relationships with case managers and medical directors, and ensure a superior experience for patients throughout the appeals process.

This is a remote position based in the United States.

What you’ll be doing

• Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive appeal submissions for commercial and government payers.
• Communicate with patients to explain appeal strategies, outline their responsibilities, and support preparation for hearings when applicable.
• Create clinical case summaries and strengthen documentation for challenging payers or those with strict coverage criteria.
• Process favorable appeal decisions promptly, negotiate payment rates through letters of agreement, and determine appropriate resolutions when denials are upheld.
• Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes.
• Deliver a superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams.
• Ensure adherence to Hillrom and third‑party payer policies while maintaining high standards of quality, compliance, and team contribution.
• Seek ongoing learning opportunities, support workload coverage, and perform additional duties or projects as assigned.

Qualifications

• Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) required, with active state licensure or certification.
• Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field.
• Minimum of 3 years of experience reviewing medical records and securing third‑party reimbursement preferred.
• Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines.
• Exceptional written, verbal, and interpersonal communication skills with strong attention to detail.
• Ability to multitask effectively, prioritize critical responsibilities, and manage time independently.
• Strong critical‑thinking and problem‑solving abilities, with comfort working both independently and within a team.
• Proficiency in Microsoft Office and related software tools.

Requirements

• Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time.

Benefits

• Comprehensive compensation and benefits packages for eligible roles.
• Health and well-being benefits including medical and dental coverage that start on day one.
• Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance.
• Employee Stock Purchase Plan (ESPP) with the ability to purchase company stock at a discount.
• 401(k) Retirement Savings Plan (RSP) with options for employee contributions and company matching.
• Flexible Spending Accounts and educational assistance programs.
• Time-off benefits such as paid holidays and paid time off ranging from 20 to 35 days based on length of service.
• Family and medical leaves of absence and paid parental leave.
• Additional benefits including commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits.